What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
Posted September 18th, 2007 by Skip
Okay. If the past week has taught me anything it has taught me that the far majority of acupuncturists don't know what we mean when we use the words "Community Acupuncture". On the forums here (you need to become a member to read them) on various blog responses, in Felice Dunas' response to her first article in AT, and just now on Ken Rose's radio show, I have heard people equating various acupuncturist initiatives with Community Acupuncture (CA) that decidedly are not CA. I understand that the words Community Acupuncture are vague. What does that word Community mean cause it could mean all sorts of things. In that sense all possible definitions of the word and of the phrase CA are valid. But what we are talking about here is something very specific, something that hasn't been done on more than very sporadically and on a very small scale in this country- maybe. But many acupunks think they know what we are talking about. So let's recap one of these things that have been said in order to draw out the differences.
CA is not like pro bono or a free clinic.
It would be fascinating to do a history of free medical clinics in this country but its beyond the scope of this post. In a nutshell though the immediate origins go back to the 60's and San Francisco especially (but not exclusively) when various groups including hippies looked for alternatives to various existing societal models including capitalism. Very prominent among these folks were the Diggers:
http://en.wikipedia.org/wiki/Diggers_%28theater%29
And the Haight-Ashbury Free Clinics, still going these 40 years:
These folks are very interesting but their origins are different than CA here. For the most part the "free" movement was a reaction to middle class values both in the US and in western Europe. Various logical ideas and trains of thought were brought to fruition in the 60's and indeed in my opinion were vital to the US back then and today too.
But two groups they didn't relate to and at times were antagonistic to were working class and middle class people who unfortunately were co-opted by both Richard Nixon and later Ronald Reagan. To working class people free clinics are not a great idea; they are a form of charity that they feel they don't deserve. The working class believe wholeheartedly in paying their way and thus have never been a part of the middle and upper middle class countercultural movement.
The idea of a free acupuncture clinic is a countercultural hangover. The idea of pro bono acupuncture care has similar roots though it is gussied up with lawyer speak. It also is not institutionalized like a free clinic is. Some acupunks say they engage in pro bono work, work on individual clients that the acupunk decides is worth it. What percentage of their work is pro bono is probably very very small and otherwise they charge high prices that most people can't afford on any sustainable basis.
Both pro bono and free clinics are non-sustainable enterprises. Both are dependent on outside funds that sooner or later dry up. Both are normally directed at the underclass by upper class or upper middle class professionals who otherwise charge rates that middle and working class people can't afford. That last statement is particularly true for pro bono work. Free clinic acupuncturists are paid by the clinic from grants of one type or another and the people who qualify for them again are the poorest of our society.
These endeavors are good at first glance- the poorest do indeed deserve decent medical care- but they neither treat the majority of the the people in this country nor are they at all common because they are so unsustainable.
CA builds sustainable clinics by charging its clients directly but at rates they can afford, often $15. The CA clinics are meant to be sustaining at that level of payment. They are not meant to subsist on the whims of charity, on the whims of rich people and/or corporations and/or governments. It's medicine for the people.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
community:
3a. Similarity or identity. b. Sharing, participation, and fellowship. 4. Society as a whole; the public. 5. (Ecology) a. A group of plants and animals living and interacting with one another in a specific region under relatively similar environmental conditions.
—American Heritage College Dictionary
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
Tess,
It seems to me like your work with 'community' clinics in the past has colored your relationship with the word itself. I think for many of us involved with CAN, the orientation with the word is....well, lighter.
One could certainly offer another appropriate singular word to describe how & why David, Tom, Korben etc. are wanting/able to run clinics for the benefit of and with the assistance of folks from all sorts of backgrounds. But 'community' has a nice way of simply incorporating that sense of belonging that many CAN'ers find intrinsically valuable.
Besides, I think it's safe to say - if WCA didn't forbid it, many of us would've borrowed the 'Working Class' moniker instead of 'community' anyway, launching its own set of detractors and kvetches.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
David, and all,
I am from owning class, but on my better days and moments, I am just a sentient being, trying to rid myself of ignorance and bias, not discriminating between other beings based on superficial layers of being such as skin color, class, belief system, sexual orientation and even species. We don't treat animals in our clinic, so I guess you can say we are discriminating there.
Community Acupuncture (I like the term and use it frequently) seems a brilliant response to our world in so many ways. In particular, it corrects an injustice which has crept into the acupuncture world in America - banishing exorbitant prices which have made this ancient medicine unavailable to all but rich people.
CAN has defined community acupuncture in certain ways (e.g. on the Locate a Clinic page). That seems necessary to establish some basic standards and I support their reasoning there.
But beyond that, I'm not too concerned with what people call their clinics or the perceived appropriation of language. There is so much variance in language use in the world today - some of it devious, but I like to think most of it not - that people are accustomed to sorting out the reality by examining actions, and not trying to pin words down to some linear, inherently existent, authoritative, once and for all meaning. Remembering that is always a good lesson for me.
I like the sounds of your clinic David. It expect it will serve your community well.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
Well, not sure how this post will be taken but just thought I'd throw my two cents in. I am one of those acupuncturists who have, for many years, provided services through government grants - specifically Ryan White funding. I have been doing this for almost 6 years. However, the powers that be decided they would cut the funding line for "holisitc therapies" in June. As such, I was left with a large number of clients who I have been treating for years who would no longer be able to afford treatment. How to deal with this? I couldn't just stop treating them. But, I need to make a living. So, I (along with a couple of others) have started a non-profit group which will be financially sustained through our sliding scale fees together with foundation money (and a few wealthy folks needing a tax donation thrown in for good measure). This will allow us to continue to provide services to a group that would not otherwise be able to continue treatment while allowomg us to make a living. I don't see how this could be labelled anything but "community" acupuncture. Our poor, our rich and all of us in between make up our communities - like it or not. Embracing all aspects, all parts of our individual members is what makes a community in my eyes.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
I love our use of the word community. Community includes everyone who lives around us, it doesn't denote a specific class. I will be treating working, middle and probably some upper class people. The beauty of a community clinic is every single one of them will get the same treatment.
I find it ridiculous that working class people would have to be spoon fed a different term as though they are incapable of understanding what we mean by community, and the beauty of that word. Nothing infuriates me more than when people feel the need to coddle and protect people of the classes below them as though working or lower class people just aren't smart enough to understand. If working class people aren't showing up at a clinic it is because outreach is missing, not because they are too confused by the word community or the sliding scale is just too crazy and complicated.
Believe it or not my working class family and neighbors love and completely comprehend the idea of community acupuncture and appreciate the sliding scale because it may allow people with less or more money to receive treatment. The people I have to go into lengthy explanation with are my middle class friends who can't comprehend not charging as much as possible.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
I first heard the term Community Acupuncture two years ago when I was practicing in Missouri and John Schmeider opened his clinic in St. Louis. When I heard the term I immediately understood that it involved treating people in a large room in chairs. I did not think of western medical community health clinics.
Our discussion of class has been interesting but divisive. I am from the middle class and we cannot afford to go to acupuncture more than once per week either. The only people who can afford the botique acupuncture prices are the owning class and these were the people I mostly treated in my clinic in Missouri.
When I open my C.A.clinic in Boston I am planning on treating people from all classes, not just working class people. There will be a sliding scale because I don't think it is confusing or hard to use.
There is nothing I can do about the class that I come from, but I do have working class friends. There is enough classism in our society, I would like to see us embrace all classes in this forum. Being the pragmatic person that I am I see C.A. as a way for our profession to survive, and help as many people as possible while earning a decent living. Let's work TOGETHER tword this!
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
Thanks, Tess. I DO understand more clearly what you're saying now. Points taken about "community" and about sliding scale vs. fixed price.
I think you're right that a lot of us have middle class and owning class backgrounds; and, of course, there's all kinds of stuff we do and think that can use checking/correction where widening access is concerned. I think since that's the central mission of what we're doing, good advice/feedback about it will be welcome. But, we're all certainly a little defensive around this stuff. That's 'cause its important and because everyone is trying stuff out.
I lived in Boston between 88 and 04'. I know right where that farm is in Lincoln. Sure do miss that beautiful land. AND, talk about confusing class stuff. Cool that you're working at the Hunger Project.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
Okay, if it was not clear what I own and it is as follows:
I worked at the Women's Needs Center (part of Haight Ashbury Free Clinics) in SF in the late 80's, a tumultuous time for Community Clinics. Lots of these clinics were losing their funding and the Women's Needs Center was in the center of a huge identity crisis. It did not know who it wanted to represent. It served largely women from middle class white backgrounds but the clientele actually matched the staff. Only all around the clinic was a huge population of underserved that would never walk into that low cost clinic because their faces were not adequately represented.
I also worked at the People's Center in Minneapolis in the 90's. It was a free clinic that also was going through a tumultuous time because the director of the clinic was trying to get rid of the union that represented the staff (the union lost in the end).
I come from a working class background. In neither of these clinics did I see many folks from working class backgrounds. Most were either middle class suburban folks though the People's Center was much more well rounded representation in staff and clientele.
The inner circle I refer in regards to this forum has to do with not whether the information in the forum is accessible (it is if you can pay for it) but if you disagree with the commonly held dictums, those ideas are not well received.
I think that Lisa and Skip have done something absolutely amazing and they are spreading their wealth in ways unheard of in many arenas, not just acupuncture (and I hope they are aware that I think this way). HOWEVER, if there is so much misunderstanding about the term Community (since it may be meaningful to some and not to others) and how it is related to working class; give it a different name. I do not understand why this is a difficult concept and why the mere mention of changing the name is so abhorrent. Me, I don't much care for the use of Community. Community clinics, like Skip mentioned in the beginning of this thread is different than what CAN intends. Its method of access is intended to be different and Skip and Lisa can bridge the gap between the historical (hippy I think you used) word Community and the current use of Community Acupuncture because they have cleverly come up with "Working Class Acupuncture." No one can mistake the intention.
So to bring this point home CRYSTAL clear, a change of name may open access to those working folks who think of community clinics as places where people get handouts, something free that they did not work for. As someone who comes from working class and someone who worked in community clinics, Skip is absolutely right about that misunderstanding. So call it something more specific instead of complaining that people don't understand what you are working towards--increased access to the working classes. Apparently co-opting an overused term does not do that.
If your clinic serves your neighborhood, good for you. The folks in your neighborhood has not a thing to do with my argument. I am arguing that community means different things to different people. It may be easier to get the working class in the clinic if you present them with a term that has meaning, not "community." That term is overused and useless in this lexicon that is being formulated through this forum.
As for the matter of sliding scale. I used to present the sliding scale to people in the low cost community clinic I worked in. The method was much more heavy handed (clinic operating funds come from any contribution you can make towards your care...but the choice about how much is yours to make) than has been suggested on this forum. For the sake of argument (I do like those, just my nature), I wonder how folks coming out of factories and into the community clinic setting interpret sliding scale? Wouldn't it just be easier to set a fixed price (say $20 per tx and $20 1st time paperwork) that is easy to read and interpret? Doesn't that go with the language and the straightforward thinking and reacting to the world of the working class.
Ah but see, that can be tried by any anyone but can be endorsed by none (except for I think Maureen in Kentucky) because the model does not fit what has come before. Except that it has. Many acupuncturists from China settled in the US have used that fee structure for many years. Low cost, easily accessible, one fee acupuncture. You may say, good for them, let them start a forum but that would be my point, this is not a forum that welcomes all comers.
One thing I am sure about on this forum. You are who you are but most of you did not come from the working class. You may be financially working class, but that is not your background. If it was, you would get more clearly what I am saying. You think I am condemning the work on this forum and that would be a big mistake to think that way.
Help people understand that this forum is open to all ideas unless the ideas are different. I love this forum but it is not an everyone is welcome here forum and nor should it.
Someone in this thread has challenged me to take responsibility for my thoughts and I feel pretty good about it.
Now I am going to can tomatoes from the Hunger Project CSA in Lincoln MA and hope that Jonah my son does not wake up with bad dreams.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
i agree with Linda (brightshen) on many points above. i just get exhausted when i get too bogged down with semantics. i think choosing words is important to a point and then our actions will do the rest of the work. i have had no trouble with he word "community", but can understand if someone does not feel it conveys the principles of this practice model and this commu... (ahem) group. what speaks louder than words is the patients' experience with our medicine and the fact that they can access acupuncture and the acupuncturist can pay their bills. i think a person of almost any background can appreciate these facts and see their value no matter what you "officially" call it. this is a new movement and it will take some explaining regardless of the name.
respectfully,
-tatyana
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
I just woke up and read this and I'm just going to put my initial somewhat irritated response here. My first reaction was, what the @#$% is that reply about? Tess, I hope you actually come from the background you profess to understand so well, I don't wish to start an argument, but my experience doesn't fit what you are saying.
I am from a working class background, many of my friends and family are in the working/lower middle class range and it's generational, there are no alienated rich kids around here. Every single person I have told about my plans to open a community clinic are thrilled with the idea. People love the sliding scale concept, no matter where they fall on it, because it implies inclusiveness. Blue collar people actually do understand words and how they might relate to concepts. It incredibly condescending to assume otherwise.
I love the term "community acupuncture" The model will be misunderstood no matter what it's called. The idea of charging high prices is so ingrained into most of us, we automatically assume making acupuncture accessible is charity and only for "poor" people. Some amount of explaining will be necessary until the clinics are commonplace.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
We will never find a name without a problem, that won't be misunderstood by some, or a name big enough to take in all that we are doing, or small enough to specify this and only this. I am OK with that.
I love the word community for what it says about the big picture. We are interdependent. We have a sense of place, of "our community". A suburb or neighborhood or town becomes a community through the interactions of its members.
That said, I think the name issue is separate and apart from the fact that most Lic Acupuncturists do not grasp the idea of a high volume, low cost, self sustaining clinic that does not survive because of fundraising or because of the "pro bono" generosity of its staff. I believe classism has a lot to do with why this is hard to grasp. From an upper middle class perspective, you either charge market rates or donate some time now and then to give free care to those needy poor people. All other options are invisible. If this is your world view, you may not be motivated to look carefully enough at the Community Acupuncture movement to understand it. I believe this problem will persist, no matter what we call it.
I agree that some people will take issue with the idea of a sliding scale. In my experience so far, this is a very small percentage of the people I see or talk to. I still think it is the best tool we have for making our treatments affordable and available.
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
I'd like to stick with you here, Tess, and give you some feedback from an east coast acupuncturist, not a WCA employee, and not really knowing what you might mean by an "inner circle".
Your response is kind of messy, in that it has a lot of strong statements not really presented as statements, almost like you don't really want to take responsibility for them. Even though, this makes them hard to respond to, I'd like to try.
I'm sorry you feel like the hopefulness CAN members are showing about a society where we make space for generosity and fairness is rhetoric somehow controlled by leadership.
I, infact, DO tune in to the forums to hear people share gushy stories about acting out of this hopefulness. It's a nice contradiction to the lies generally and constantly misted out at us from the goings-on of hyper-capitalism.
I also, infact, DO tune in for good thinking about class and race. What a relief that people, especially white middle class folks are actually discussing these things and looking for help from each other to stop perpetuating and actively resist the classism and racism we all get so well trained in.
So, no, this dialogue is not "reserved for the inner circle".
I would suggest that we all have a lot of feelings about leaders in our lives, from parents to politicians. In relation to leaders we have felt frequently powerless or invisible, abused or exploited, sent to war or to prison or to a life of being unconnected to others. Most of us have a hard time trusting people who get out front and lead or be powerful. It usually means that we don't get out front and lead or be powerful ourselves, which is convenient for the leaders that really aren't to be trusted.
There are a couple people who have certainly played key roles in the genesis and momentum of community acupuncture in the U.S. And, fortunately for everyone, those people have a strong anti-oppressive take on leadership and organizations, and have spent the last two years sharing good ideas, setting up systems by which an important organization gets to be as democratic as possible, facilitating others to lead and be powerful, and generally just championing the simple idea of returning natural and effective healthcare back to a human right.
I'm intelligent, like you, and you can bet I'm over here doing some thinking of my own. Lisa and Skip and Lupine just happen to have done a lot of good thinking and, along with countless others, cohered some pretty fine systems which are helping alot of us act out of our generous and just human natures, do really good acupuncture, and make a living.
Lastly, I'm quite comfortable with the term community, and I'll tell you why. My partner and I opened a community acupuncture clinic in Philly 5 weeks ago. We saw close to a hundred patients last week. Of the more than 200 people we've treated so far, more than 90% live within 6 blocks, walking distance of the clinic. That's community.
That's a pretty nice percentage of the neighborhood who are coming in for acupuncture already. We all knew this before, but these numbers make it pretty clear that there is a need for affordable and affective and local health care. The vast majority of our patients have either never had acupuncture or have had acupuncture but cannot afford it at boutique prices. They're expressing a lot of gratitude, and coming back for more.
And, that's because acupuncture works, because the sliding scale makes it affordable, and because there is something right about being able to go get treatment in a beautiful sanctuary with your neighbors regularly. That's community.
-Korben
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
um
I did not put in all those question marks
so deal with the major formatting error, kindly
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
Perhaps its that true blue American individualism (or some vast red state conspiracy) ?that smarts from using community with a "C" ??"community professional services" ?would sound like it was pro bono, too ?or some hippy leftovers (probably chockful of garbanzos) ??group acupuncture? ~ group therapy? ????but group activity is done if you go to barber shops, nail salons, laundromats, ?church, sporting events, public transport, farmers markets, malls? ??or even if a tragedy/ bad weather brings people out to help "oneanother" ??Do we talk about our "community" or neighborhood or block or team or posse or crew or peeps ?hey, i need my peeps ??WCA plays up these classo/politico themes that may make nervousness with humorous "communist/Labor" like emblems ?disarming ...so to speak ?and intriguing ??( they still have/had to prove themselves everyday like any small business) ????Really tho' ?Community Acupuncture is mostly an internal acupuncture profession academic term........not really wikipedia yet.. ?.a working title.....as it were ?something to signify whats going on, whats different from the "other" business models ?boring stuff for the unliscensed folk ???non-acu-folk will understand affordable effective care but still need clarification with the word acupuncture ??yet someone tells them to try it.............................................. ????????then ??they will experience: ?1) the marvels of their body via acupuncture,
2) the acce$$ibilty of this format, and ?3) cop some free qi from their neighbors yuan stash???feel around! people are hungry for true broad local relationships ??
get your togetherness, baby!
Re: What Community Acupuncture Is Not, Part One- Free Clinics & Pro Bono Work
Tess, your response deserves a thread all its' own.
I think a good night's sleep is needed before I rip into it, however...
Until Then,
Andy Wegman
The case of mistaken identity
I just have to get this off my mind and this is a good subject and indirectly I have brought this up before. There are 2 things you spoke about which I would like to challenge.
1) Community Clinic sounds synonymous with Community Acupuncture and folks that have traditionally been adverse (the working class) to the concept of "free" are often adverse to the concept of sliding scale. You charge a price and you stick to it damn it! No willy nilly feel good "pay what you can afford" sliding scale. So, don't you think that a sliding scale is off-putting and alienating as well? How many of your clients have generational roots in that class?
I worked for the Haight Ashbury Free Clinics and the few folks who were truly from the working class that came to the clinic (most of them were alienated children of the upper white suburban class) tended to stress over the sliding scale and would often insist on paying more than I suspected they could afford (I was a receptionist). The aliented children of the upper white suburban class tended to pay nothing. I only know this because I knew some of these people outside of the clinic and I knew their backgrounds.
2) Why co-opt a word (Community) that is traditionally alienating to the very community you target? Why not be "sliding scale" acupuncture, affordable acupuncture, nuts and bolts acupuncture, underpaid workers acupuncture, blue collar acupuncture (carefully avoiding the phrase already owned in Portland)? Why fight the misunderstood word? If so many people don't get it, maybe the acupuncture model should be spelled out a little more clearly?
Someone on the forum was complaining about the "tone" some folks on this forum used. At first I was annoyed with her comments that people on the forum were condescending and not inclusive because I didn't agree. However, if "community" was not trying to be owned by this forum, opting instead for a different word connoting something more specific than "your people," maybe the tone on the forum would be less amenable to a difference of model (for example, a hybrid) by its very definition and therefore the tonal problem may not come up or at least less often.
If soooo many people are complaining about or just plain misunderstanding what the model is representing in regards to Community, don't make it Community! Like large corporations (most of you won't like this analogy but here goes) who come under fire for their horrific environmental policies simply change their name to be less recognizable. It's the same idea but opposite (CAN is struggling to be clearer and Dow is trying to hide behind the chemical cloud).
So if the "community" of acupuncturists on this forum really want to follow the model set forth by Lisa and Skip at WCA, call it something else. Because frankly, most acupuncturists do not care or at least not care deeply for serving the working class. Most acupuncturists I know do not come from the working class. They just want to be able to make a living and practice the acupuncture they want to practice in the way they were taught in school (or the latest hot teacher). If they can have a "sliding scale" clinic thrown in once a week while booking the more expensive treatments the rest of the week to boost business, they will. They want the info. on this forum not for lessons on class or race or molotov cocktail throwing, but for the nuts and bolts of the business model. They are perhaps becoming disappointed with rhetoric about the generosity that exists in this arena because that seems to be reserved for those in the inner circle. The true "community acupuncturists."
There is a fairly simple fix. Don't call WCA model "Community Acupuncture." It's not fair to acupuncturists who think the idea is inclusive and it may not be fair to patients who may not choose "sliding scale," even if it is affordable. Most free clinics are not generally free, they just advertise themselves as such.
I am happy to support the forum and everyone's ideas (even the one's I don't like) and this is not a condemnation about anyone but it seems it is just a case of mistaken identity.
Whoooo are you? Who who who who? Now tell me who are youuuuu?